Ch 27: Newborn at risk

London_4e_TB_Ch27.doc.docx

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Question Stem The nurse is caring for pregnant patients. Which of these clients should the nurse anticipate is most likely to have a newborn at risk for mortality or morbidity?

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Answer Choice 137-year-old G8 P2323, works in a chemical factory

Rationale 1This patient is at greatest risk because she has multiple risk factors: age over 35, high parity, history of preterm birth, and exposure to chemicals that might be toxic.

Answer 1true

Choice 223-year-old primip, low socioeconomic status, unmarried

Rationale 2The main risk factor for this patient is her low socioeconomic status.

Answer 2false

Choice 316-year-old primip, began prenatal care at 30 weeks

Rationale 3This patient has two risk factors: young age and late onset of prenatal care.

Answer 3false

Choice 428-year-old G2 P1001, history of gestational diabetes

Rationale 4This patient has gestational diabetes history as her only risk factor.

Answer 4false

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Meta 4 Learning Outcome 1:LO01 - Explain the factors present at birth that indicate an at-risk newborn.

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Question Stem Small-for-gestational-age infants often have complications at birth, but they may also experience long-term complications. The long-term effect that is most likely to occur in SGA infants is:

Stimulus

Answer Choice 1Change from thin and underweight as a child to overweight or obese as adolescents

Rationale 1This long-term effect is often seen in children with fetal alcohol syndrome, not SGA.

Answer 1false

Choice 2Poor fine motor coordination

Rationale 2SGA infants are likely to develop cognitive disabilities such as poor fine motor coordination, hyperactivity, learning disabilities, and hearing loss.

Answer 2true.

Choice 3Paralysis below the hips

Rationale 3Many infants with myelomeningocele will suffer life-long paralysis below the site of the cyst. Paralysis is not generally associated with SGA infants.

Answer 3false

Choice 4Permanent disfiguration

Rationale 4Although it may occur, disfiguration is not commonly associated with SGA infants. Instead, disfiguration is more likely to remain in infants with congenital anomalies such as cleft lip/cleft palate, even after corrective surgery.

Answer 4false

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Meta 4 Learning Outcome 1:LO02 - Compare the underlying etiologies of the physiologic complications of small-for-gestational-age (SGA) newborns and preterm appropriate-for-gestational-age (Pr AGA) newborns, and the nursing care management for each.

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Question Stem A 38-week newborn is found to be small for gestational age. Which of the following nursing interventions should be included in the care of this newborn?

Stimulus

Answer Choice 1Monitor for feeding difficulties.

Rationale 1LGA newborns are more difficult to arouse to a quiet alert state and can have feeding difficulties.

Answer 1false

Choice 2Assess for facial paralysis.

Rationale 2LGA newborns often are prone to birth trauma, such as facial paralysis, due to cephalopelvic disproportion.

Answer 2false

Choice 3Monitor for signs of hyperglycemia.

Rationale 3SGA newborns are more prone to hypoglycemia.

Answer 3false

Choice 4Maintain a warm environment.

Rationale 4Hypothermia is a common complication of the SGA newborn; therefore, the newborns environment must remain warm to decrease heat loss.

Answer 4true

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Client Need Sub:Reduction of Risk Potential

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Meta 4 Learning Outcome 1:LO02 - Compare the underlying etiologies of the physiologic complications of small-for-gestational-age (SGA) newborns and preterm appropriate-for-gestational-age (Pr AGA) newborns, and the nursing care management for each.

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Question Stem A 7 pound, 14 ounce girl was born to an insulin-dependent type 2 diabetic mother two hours ago. The infants blood sugar is 45mg/dl. The best nursing action is:

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Answer Choice 1Recheck the blood sugar in four hours.

Rationale 1Infants of diabetic mothers should be fed frequently and should have their blood sugar assessed frequently. Four hours is too long a time frame.

Answer 1false

Choice 2Begin an IV of 10% dextrose.

Rationale 245mg/dl is considered a normal blood sugar reading for a neonate. No IV is needed.

Answer 2false

Choice 3Feed the baby one ounce of formula.

Rationale 3Feeding would be appropriate if the infants blood sugar was below 40, but this infants reading is 45 mg/dl.

Answer 3false

Choice 4Document the findings in the chart.

Rationale 4A blood sugar of 45 mg/dl is a normal finding; documentation is an appropriate action.

Answer 4true

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Meta 4 Learning Outcome 1:LO03 - Explain the impact of maternal diabetes mellitus on the newborn.

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Question Stem An infant was born at 31-weeks gestation and weighed 1430 g. What is the correct initial feeding regimen for this infant?

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Answer Choice 110 mg/kg/day of premature formula 24 kcal/oz.

Rationale 1This is the correct initial feeding regimen for preterm infants with a birth weight under 1250 g.

Answer 1false

Choice 220 mg/kg/day of premature formula 24 kcal/oz.

Rationale 2This is the correct initial feeding regimen for preterm infants with a birth weight between 1251 and 1500 g.

Answer 2true

Choice 340 mg/kg/day of postdischarge formula 22 kcal/oz.

Rationale 3This is the correct initial feeding regimen for preterm infants with a birth weight between 1801 and 2500 g.

Answer 3false

Choice 450 mg/kg/day of term formula 20 kcal/oz.

Rationale 4This is the correct initial feeding regimen for preterm infants with a birth weight over 2500 g.

Answer 4false

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Meta 4 Learning Outcome 1:LO05 - Discuss the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and that are used in developing a plan of care that includes nutritional management.

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Question Stem The pregnant patient at 41 weeks is scheduled for labor induction. She asks the nurse if induction is really necessary. What response by the nurse is best?

Stimulus

Answer Choice 1Babies can develop postmaturity syndrome, which increases their chances of having complications after birth.

Rationale 1This statement is correct.

Answer 1true

Choice 2When infants are born two or more weeks after their due date, they have meconium in the amniotic fluid.

Rationale 2Although this statement is partially true, meconium-stained amniotic fluid is not always present or the only complication of postmaturity syndrome.

Answer 2true

Choice 3Sometimes the placenta ages excessively, and we want to take care of that problem before it happens.

Rationale 3Although this statement is true, it is too vague. It is better to be specific and call postmaturity syndrome by its name.

Answer 3false

Choice 4The doctor wants to be proactive in preventing any problems with your baby if he gets any bigger.

Rationale 4Although this is true, the answer is incomplete. The risk of postmaturity syndrome is also an issue.

Answer 4false

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Meta 4 Learning Outcome 1:LO04 - Compare the characteristics and potential complications that influence nursing management of the post-term newborn and the newborn with postmaturity syndrome.

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Question Stem The nurse is working with a family that just experienced the birth of their first child at 34 weeks. Which statements indicate that additional teaching is needed?

Standard TextSelect all that apply.

Stimulus

Answer Choice 1Our baby will be in an isolette to keep him warm.

Rationale 1Preterm infants have little subcutaneous fat and have difficulty maintaining their body temperature. An isolette or overhead warmer is used to keep the baby warm.

Answer 1false

Choice 2Breathing might be harder for our baby because he is early.

Rationale 2Surfactant production might not be complete at 34 weeks, which leads to respiratory distress syndrome. In addition, respiratory effort is increased when the ductus arteriosus remains patent, which is common in preterm infants.

Answer 2false

Choice 3The growth of our baby will be faster than if he were term.

Rationale 3Preterm infants grow more slowly than do term infants.

Answer 3true

Choice 4Tube feedings will be required because his stomach is small.

Rationale 4Although tube feedings might be required, it would be because preterm babies lack sufficient suck and swallow reflexes to prevent aspiration.

Answer 4true

Choice 5Because he came early, he will not produce urine for two days.

Rationale 5Although preterm babies have diminished kidney function due to incomplete development of the glomeruli, they will make urine.

Answer 5true

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Question Stem The nurse is caring for an infant with abdominal contents protruding out approximately at the location of the umbilicus. What is the primary mechanism used to differentiate between omphalocele or gastroschisis?

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Answer Choice 1With omphalocele, the abdominal contents are covered with a sac; with gastroschisis, the abdominal contents are not covered by a sac.

Rationale 1If the abdominal contents are covered by a sac, it is omphalocele. However, if the abdominal contents are not covered by a sac, it could be either omphalocele or gastroschisis. The better way to differentiate between omphalocele and gastroschisis is that the abdominal contents protrude into the base of the umbilical cord in omphalocele but protrude to the right of the umbilical cord in gastroschisis.

Answer 1false

Choice 2With omphalocele, the abdominal contents are not covered with a sac; with gastroschisis, the abdominal contents are covered by a sac.

Rationale 2If the abdominal contents are covered by a sac, it is omphalocele. However, if the abdominal contents are not covered by a sac, it could be either omphalocele or gastroschisis. The better way to differentiate between omphalocele and gastroschisis is that the abdominal contents protrude into the base of the umbilical cord in omphalocele but protrude to the right of the umbilical cord in gastroschisis.

Answer 2false

Choice 3With omphalocele, the abdominal contents protrude to the right of an intact umbilical cord; with gastroschisis, the abdominal contents protrude into the base of the umbilical cord.

Rationale 3This is the opposite description of gastroschisis and omphalocele. With omphalocele, the abdominal contents protrude into the base of the umbilical cord; with gastroschisis, the abdominal contents protrude to the right of an intact umbilical cord.

Answer 3false

Choice 4With omphalocele, the abdominal contents protrude into the base of the umbilical cord; with gastroschisis, the abdominal contents protrude to the right of an intact umbilical cord.

Rationale 4This is a correct way to differentiate between omphalocele and gastroschisis.

Answer 4true

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Meta 4 Learning Outcome 1:LO06 - Summarize the nursing assessments of and initial interventions for a newborn with selected congenital anomalies.

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Question Stem The nurse is assessing a 36-week gestational age newborn. Upon auscultation, she hears a late systolic murmur in the left intrascapular area with no femoral pulse but increased brachial pulses. What treatment should this infant receive?

Stimulus

Answer Choice 1Indomethacin with surgical ligation.

Rationale 1This treatment is used with patent ductus arteriosus. This infant has coarctation of aorta, which should be treated with prostaglandin E1 and surgical resection of the aorta.

Answer 1false

Choice 2Lanoxin with surgical closure with a Dacron patch.

Rationale 2This treatment is used for ventricular septal defect. This infant has coarctation of aorta, which should be treated with prostaglandin E1 and surgical resection of the aorta.

Answer 2false

Choice 3Prostaglandin E1 and surgical resection of the aorta.

Rationale 3This is the correct treatment for an infant with coartation of aorta.

Answer 3true

Choice 4Palliative surgery to increase blood flow to the lungs followed by corrective surgery.

Rationale 4This treatment is used for tetralogy of Fallot. This infant has coarctation of aorta, which should be treated with prostaglandin E1 and surgical resection of the aorta.

Answer 4false

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Meta 4 Learning Outcome 1:LO09 - Identify the physical examination findings during the early newborn period that would make the nurse suspect a congenital cardiac defect or congestive heart failure.

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Question Stem The nurse is caring for a newborn in the special care nursery. The infant is positioned prone and has hydrocephalus. The nurse is especially careful to cleanse all stool after bowel movements. This care is most appropriate for an infant born with:

Stimulus

Answer Choice 1Omphalocele.

Rationale 1Omphalocele is a herniation of abdominal contents into the base of the umbilical cord. Positioning on the abdomen would be detrimental. Hydrocephalus is not associated with omphalocele.

Answer 1false

Choice 2Gastroschisis.

Rationale 2Gastroschisis is a full-thickness defect of the abdominal wall, resulting in the abdominal organs being located on the outside of the body. Positioning on the abdomen would be detrimental. Hydrocephalus is not associated with this condition.

Answer 2false

Choice 3Diaphragmatic hernia.

Rationale 3Diaphragmatic hernia is incomplete formation of the diaphragm, resulting in bowel and sometimes stomach extending upward through the defect and being located in the chest cavity. Respiratory distress is the primary symptom. Surgical repair is required for normal respiratory function if the lungs have not been compromised by crowding from abdominal organs. Positioning should be high Fowlers to facilitate respiratory efforts. Hydrocephalus is not associated with this condition.

Answer 3false

Choice 4Myelomeningocele.

Rationale 4Myelomeningocele is a neural tube defect in which the meninges and spinal cord are exposed. Surgical repair is undertaken to prevent encephalitis. Meticulous cleaning of the perineum helps prevent infection. The infant is positioned prone to prevent pressure on the defect. Hydrocephalus often is present.

Answer 4true

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Question Stem Parents have been told their child has fetal alcohol syndrome. Which statement indicates that additional teaching is required?

Stimulus

Answer Choice 1Our babys heart murmur is from this syndrome.

Rationale 1Ventral and atrial septal defects are common in babies with FAS.

Answer 1false

Choice 2He might be a fussy baby because of this.

Rationale 2FAS babies are easily overstimulated and have feeding difficulties, leading to more crying than an average baby.

Answer 2false

Choice 3His face looks like it does due to this problem.

Rationale 3Facial characteristics of the FAS child include a broad and flat nasal bridge, wide-set eyes, small chin, and smooth philtrum.

Answer 3false

Choice 4Cuddling and rocking will help him stay calm.

Rationale 4FAS babies are easily overstimulated and tend to cry more if swaddled, cuddled, or rocked. A dark and quiet environment helps keep the child calm.

Answer 4true

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Meta 4 Learning Outcome 1:LO07 - Explain the special care needed by an alcohol- or drug-exposed newborn.

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Question Stem The nurse is caring for a newborn born to a drug-addicted mother. Which of the following assessment findings would be common for this newborn?


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Answer Choice 1Hyperirritability

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Answer 1true

Choice 2Decreased muscle tone

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Answer 2false

Choice 3Exaggerated reflexes

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Answer 3true

Choice 4Depressed respiratory effort

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Answer 4false

Choice 5Transient tachypnea

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Answer 5true

Global RationaleNewborns born to drug-addicted mothers exhibit hyperirritability, exaggerated reflexes, and transient tachypnea.



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Question Stem Which of the following should be considered potentially infectious when providing nursing care for a newborn with an HIV-positive mother?


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Answer Choice 1Soiled linens

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Answer 1true

Choice 2Urine

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Answer 2true

Choice 3Blood

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Answer 3true

Choice 4Mask worn while caring for infant

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Answer 4false

Choice 5Feces

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Answer 5true

Global RationaleBody fluids such as blood, urine, and feces are considered potentially infectious. Therefore, soiled linens are also potentially infectious. A mask is not routinely used when caring for an infant exposed to HIV and will likely not be contaminated if used.


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Meta 4 Learning Outcome 1:LO08 - Relate the consequences of maternal HIV/AIDS to the nursing care management of infants at risk for HIV/AIDS in the neonatal period and the issues for their caregivers.

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Question Stem The family of a newborn has just been told their infant has tetralogy of Fallot. The family does not seem to understand the explanation given by the physician. What statement by the nurse is best?

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Answer Choice 1With this defect, not enough of the blood circulates through the lungs, leading to a lack of oxygen in the babys body.

Rationale 1Tetralogy of Fallot is a cyanotic heart defect that is comprised of four abnormalities: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricle hypertrophy. Deoxygenated blood is shunted from the right ventricle through the VSD into the left ventricle, bypassing the lungs and circulating de-oxygenated blood.

Answer 1true

Choice 2The babys aorta has a narrowing in a section near the heart that makes the left side of the heart work harder.

Rationale 2This describes coarctation of the aorta, which is not a cyanotic heart defect but an obstructive defect to systemic blood flow.

Answer 2false

Choice 3The blood vessels that attach to the ventricles of the heart are positioned on the wrong sides of the heart.

Rationale 3This describes transposition of the great vessels.

Answer 3false

Choice 4Your babys heart doesnt circulate blood well because the left ventricle is smaller and thinner than normal.

Rationale 4This describes hypoplastic left heart syndrome.

Answer 4false

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Question Stem The nurse is caring for a 2-hour-old newborn whose mother is diabetic. The nurse assesses that the newborn is experiencing tremors. What nursing action has the highest priority?

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Answer Choice 1Obtain a bilirubin level.

Rationale 1Bilirubin level also might be necessary to monitor, but does not present with tremors in the newborn.

Answer 1false

Choice 2Obtain a blood calcium level.

Rationale 2Tremors are the classical sign for hypocalcemia. Diabetic mothers tend to have decreased serum magnesium levels at term. This could cause secondary hypoparathyroidism in the infant.

Answer 2true

Choice 3Take the newborn's temperature.

Rationale 3Body temperature also might be necessary to monitor, but does not present with tremors in the newborn.

Answer 3false

Choice 4Place a pulse oximeter on the newborn.

Rationale 4Oxygen saturation also might be necessary to monitor, but does not present with tremors in the newborn.

Answer 4false

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Meta 4 Learning Outcome 1:27.3 Explain the impact of maternal diabetes mellitus on the newborn.

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Ch 27: Newborn at risk